VA Academic Detailing Service: Implementation and Lessons Learned
Program Materials
The key components of the VA AD Service were educational outreach programming, informatics tool development and dissemination, and barrier resolution. The first step in each campaign was the development of educational program materials designed to facilitate discussion and promote evidence-based practice. The academic detailers along with key VA thought leaders developed provider handouts, provider pocket cards, and patient education materials to support each educational topic. The program materials required the translation of evidence-based research into clinical practice and strategic educational and operational development by individuals who understand complex pharmacotherapy.
Provider handouts, embedded with key messages, served as a summary guide to the information presented and included action statements that highlighted recommendations that would influence behaviors. The handout content reflected recommendations based on the VA/DoD Practice Guidelines, the VA National Formulary, and relevant new and emerging literature on the mental health topic being addressed. When possible, existing VA/DoD and MHS educational resources were used to supplement the handouts.
The pocket cards provided actionable information about treatment recommendations. For example, the provider handout for posttraumatic stress disorder (PTSD) recommended to “consider prazosin for use in veterans with combat associated nightmares” and reviewed the literature to support that recommendation. These pocket cards also provided information on prazosin dosing, titration, common drug interactions, and adverse effects. In addition, patient education resources such as handouts and brochures were designed to engage veterans in their mental health care. These educational materials were vital to ensuring the VA workforce and the veterans being served were well educated on evidence-based treatment and acting on the evolving information produced by the latest research.
Academic detailers used these tools during educational outreach sessions to inform and assess the provider’s knowledge of evidence-based treatment and to review areas where the provider desired further education of the evidence. These educational sessions focused on leadership in mental health, pharmacy service, the medical center overall, and priority clinicians identified as having the greatest opportunity for change. Academic detailers also met with the priority provider clinical support teams (nurses, pharmacists, social workers, psychologists, dieticians, etc) to ensure that the message passed along to veterans was consistent among all team members. Clinicians with the greatest opportunity for change, or priority HCPs, varied based on the particular educational topic. For example, if the educational topic were focused on PTSD, prescribers with large panels of patients with PTSD would be prioritized. Investment in the educational outreach specifically identified clinicians who had the greatest opportunity to transform practice with the clinical recommendations, which in turn, identified the greatest opportunity for the academic detailer to influence behavior changes and improve health care for veterans.
Dashboard
Clinicians were identified by the AD Service using the AD dashboard. This informatics tool included actionable patient information, which was developed for each educational topic. The dashboards were available for use by both academic detailers and clinical team members to support evidence-based treatment and to seek patients who might benefit from an evaluation of care. These audit and feedback tools leveraged regional and national data to produce a clinical performance dashboard that generated visually intuitive reports at the VISN, station, provider, and individual patient levels. Data collection for the dashboards included robust and complex data sets that were updated daily. These tools allowed clinicians to see a snapshot of their patient panel and assess patient-level information in order to change individual care.
Barrier resolution and implementation support is another important aspect of the VA AD program. Education without system solutions is cause for provider and patient frustration. Academic detailers worked with their local site to identify available resources, and they often resolved problems within the system to promote evidence-based treatment. Examples included assisting with the clozapine registration process, creating quick orders to assist with dosing for commonly used medications, and creating treatment letters within the computer system that HCPs could quickly send to the patient. Each academic detailer also worked with local facilities to assess where policies and protocols could support the AD campaign initiatives. Resources at each VA required tailored solutions and collaboration with leadership, and clinicians at each site were key to a successful AD program.
